Prevention in proportion

Difficult decisions about where to direct limited resources are being made across the country.

When times are tough, spending decisions about risk management are particularly difficult for local authorities because they are active in so many diverse areas including road safety, play safety, occupational safety and home safety.

The idea of ‘prevention in proportion’, one of the Royal Society for the Prevention of Accidents’ guiding principles, is not only ideal for keeping safety in perspective and helping to prevent over-the-top decisions, it is also the perfect mantra for managing health and safety during difficult economic times.

The safety charity, which has been at the forefront of accident prevention for more than 90 years, has been keen to promote the message that prevention makes good economic sense, particularly when it is more difficult to offset continuing accident and ill health losses by increasing income.

In the public services arena, RoSPA has cautioned against making blanket cuts that result in entire services going, such as school crossing patrols. It acknowledges that no area is immune from having to make cost savings, but urges that informed decisions are taken, with evidence and data as their foundation.

A key concept, relevant to all types of safety intervention, is evaluation: demonstrating the effectiveness of what a department does is vital. Evaluating work not only helps to make a case for allocating scarce resources but also means resources can be directed to activities that are likely to have the greatest impact.

Road safety budgeting
With many local authorities still discussing the impact of at least 27 per cent cuts to their road safety budgets, it is important that decisions are not taken hastily which may prove irreversible.

Several road safety funding issues have raised their heads in the past few months and made headlines in national and local newspapers. While public spending needs to be cut, cuts must be justified by evidence.
Though the government has insisted that road safety should remain a priority for councils, local authorities no longer receive funding from the Treasury that can be used to support safety camera programmes. This means local authorities have had to decide on the fate of their existing speed cameras.

The fact is speed cameras do help to save lives – an estimated 100 lives a year in the UK, and switching off cameras systematically would be tantamount to creating a void in law enforcement on the road. Cameras currently account for 84 per cent of fixed penalty notices for speeding.

RoSPA believes that cameras should continue to be used where casualty statistics show they are needed. Speeding significantly increases the risk of an accident happening; and also increases the severity of injuries in an accident.

Budget cuts might also threaten many speed awareness courses that give motorists an opportunity to learn about the dangers of driving too fast. Cameras pay for themselves and currently make an important contribution to achieving compliance with the speed limit.

School crossing patrols have also come under threat from spending cuts, which are being made across the board. School crossing patrols provide a valuable safety service for children crossing roads on their way to and from school. At a time when parents are being encouraged to ensure their children are keeping fit and active by walking to and from school, RoSPA hopes that as many patrols as possible would be kept in use.

The purpose of disestablishing a crossing patrol site should not be to save money, but should be to divert the patrol to another site where there is a greater need for its services.

Street Lighting
In many areas local authorities have been turning off, or down, street lighting on certain stretches of road and motorway to reduce emissions/carbon footprint and save money.

These are valid reasons for doing so; however it does potentially increase the risk of road accidents, especially in the early hours of the morning when drivers are more likely to be tired and less alert.

It is also important to remember that for emergency services personnel and vehicle breakdown/recovery people, the motorway is often their working environment. Dealing with a broken down vehicle or the aftermath of a crash on a motorway is difficult and dangerous enough in lit conditions; in the dark it will be even trickier.

Sites where lights are turned off or down should be chosen only after a careful and thorough risk assessment, and the effects of the change in lighting should be carefully monitored. If problems occur, it is hoped that local authorities would acknowledge that the experiment did not work, and switch the lights back on.

Evaluation in road safety, as in any other area of safety interventions, is vitally important. Demonstrating the value of road safety schemes and improving the targeting, design and delivery of interventions have become all the more important. Good evaluation can be used as evidence to support the need for road safety funding and prioritisation.

Evaluate Safety Activities
E-valu-it is a free online resource to help road safety practitioners evaluate their education, training and publicity activities and has been produced by the Department for Transport and RoSPA. It helps practitioners plan, carry out and report the results of road safety intervention evaluations and is available from www.roadsafetyevaluation.com.

The system produces bespoke recommendations based on the answers a practitioner gives to a series of questions and it can be used for interventions that are planned, in progress or have already taken place.

Key elements of the road safety evaluation tool are easily adaptable to other areas of safety, and safety professionals who are not sure where to start could do worse than to take a look at the toolkit.

There are also links between road safety and public health – transport policy has a big influence on health. There are common approaches to preventing both ill health and injury by getting transport policy right.

Similarly, many public health approaches (for example to tackle inequalities or to provide support for parents in the early years of their child’s life) will also have an influence on the number of road injuries and local authorities may be able to enhance the road safety benefits of current public health activities by making the links more explicit. Ultimately a safe environment that people are not afraid of using is also a healthy one with a lot of active travel.

As safe as necessary
As with road safety, local authorities are finding that they have to review their spending on play safety management, finding ways to move forward when budgets are being reined in.

At the top of the list of considerations about play safety management, RoSPA would encourage providers to recognise that play, and playgrounds, should be as safe as necessary, not necessarily as safe as possible. Play should be about children having fun and learning to manage risk through adventurous activity.

Experiencing risks enables children to develop the skills necessary to deal with them when they are older, and bumps and bruises are an important part of growing up. Health and safety legislation also has proportionality at its heart, with the Health and Safety at Work Act (HSAW) 1974 stating that safety should be protected ‘as far as is reasonably practicable.’

Over-the-top safety procedures are not only detrimental to children’s fun and development, they cost extra money that authorities can ill afford.

Having said that, while we caution against wrapping children in cotton wool, there are very serious accidents that we would want them to avoid. A robust and sensible risk assessment process will enable local authorities and playground managers to work out where to focus attention and resources, so that unacceptable risks can be reduced and over-the-top actions on trivial risks can be avoided.

Look upon risk assessment as a useful working tool to help prioritise action – and ensure that the process is not over-complicated. Applying the ‘Goldilocks principle’ will help to save time and money in the long run: safety should be balanced – neither too lax, nor over the top, but just right.

Installing new equipment in times of restricted resources will be difficult if not impossible, so local authorities should recognise the value of good annual inspections and routine safety checks. Spotting issues such as the early stages of wear and tear, or vandalism, enables them to be dealt with before they become expensive problems.

Cost saving can be taken even further by ensuring that authorities’ own staff are trained to carry out regular inspections, with in-house training available from external organisations such as RoSPA.

Getting the balance right
Although, thankfully, in the UK notifiable fatal and serious injuries in the workplace are reducing, there are still more than one million injuries to workers annually and more than two million cases of ill health caused or made worse by work. Many thousands are still dying prematurely as a result of conditions such as occupational cancer. The annual cost to the economy is in the region of £30billion.

Despite this scale of tragedy and loss, companies that are hard pressed, especially during tough economic conditions, may ask quite understandably why they should devote precious money – and even more precious time – to upgrading their health and safety management regimes.

The Goldilocks principle can equally be applied to the workplace, with employers needing to ensure that environments are safe so far as is reasonably practicable. The real importance of this is that it allows proportionality of response to risk, taking account of different variables. The only alternative to this is a rising scale of specific prescriptive solutions laid down in law. Not only would this would be cumbersome but it would lead to both ‘under-hitting’ and ‘over-hitting’. Reasonable practicability allows for fine tuning.

Making sound judgements about such risk/cost optimisation can pose real challenges for those firms lacking the necessary skills or access to professional expertise, particularly where options must be chosen from a range of solutions. For example, to take a case related to public safety, reasonably practicable water edge treatments to prevent drowning can vary from little or no action, to shelving and/or planting edges and erecting signage, through to extensive physical barriers at the extreme.

Training
Training in the risk assessment process to ensure staff get it right is an investment that will pay dividends; not only in preventing serious accidents, but in directing resources where they are needed most, rather than wasting money on trivial issues that present a negligible risk.

When it comes to investing in health and safety, it is not just a case of doing so because it is the right thing; it is also underpinned by a very strong business case. Furthermore, although it might seem wholly counter-intuitive, that case is even stronger when times are tough than it is at other times. The reason is very simple: accidents and ill health caused by work (not to mention non-injury incidents which are much more numerous) impose massive – but largely unrecognised – costs on business.

The Health and Safety Executive (HSE) has estimated that the ratio between insured and uninsured costs arising from accidents lies in the range of 1:8 to 1:36. So in the worst case, for every £100 recovered from the insurer, the business loses about £3,600.

A worthwhile effort
Properly-focused action to prevent accidents makes very good economic sense. Putting some effort into prevention in the right way can save a lot of money and heartache further down the line – both for local authorities and for society as a whole.

Everyone knows that prevention is better – and cheaper – than cure. At an NHS and societal level, the financial burden of accidents is eye-watering. In 2001, the annual cost of accidents to the NHS in England alone was estimated at £2.2 billion. This figure could now be in the region of £5-7 billion. The cost to the NHS is just the tip of the iceberg; home and leisure accidents prompting a trip to A&E cost UK society as a whole £94.6 billion every year.

Numerous studies have shown that accident prevention projects are easy to implement, inexpensive to deliver and have impressive return on investment potential. In Dudley, a falls prevention programme comprising home assessments and exercise sessions, for which the £158k a year costs were funded by the primary care trust and council, saved £3 million over five years due to the corresponding reduction in hip fractures.

Getting health and safety judgements right is not always easy, but if they help to save lives, reduce injuries and safeguard health without wasting scarce resources, then the effort involved is surely worthwhile.